DSM-5 & SLDs

The upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) takes

a different approach to learning disorders than previous editions of the manual by broadening the

category to increase diagnostic accuracy and effectively target care. Specific learning disorder is now a

single, overall diagnosis, incorporating deficits that impact academic achievement. Rather than limiting learning disorders to diagnoses particular to reading, mathematics and written expression, the criteria describe shortcomings in general academic skills and provide detailed specifiers for the areas of reading, mathematics, and written expression.

Characteristics of Specific Learning Disorder

Specific learning disorder is diagnosed through a clinical review of the individual’s developmental,

medical, educational, and family history, reports of test scores and teacher observations, and response

to academic interventions. The diagnosis requires persistent difficulties in reading, writing, arithmetic, or mathematical reasoning skills during formal years of schooling. Symptoms may include inaccurate or slow and effortful reading, poor written expression that lacks clarity, difficulties remembering number facts, or inaccurate mathematical reasoning.

Current academic skills must be well below the average range of scores in culturally and linguistically

appropriate tests of reading, writing, or mathematics. The individual’s difficulties must not be better

explained by developmental, neurological, sensory (vision or hearing), or motor disorders and must significantly interfere with academic achievement, occupational performance, or activities of daily living.

Because of the changes in DSM-5, clinicians will be able to make this diagnosis by identifying whether

patients are unable to perform academically at a level appropriate to their intelligence and age. After a

diagnosis, clinicians can provide greater detail into the type of deficit(s) that an individual has through

the designated specifiers. Just as in DSM-IV, dyslexia will be included in the descriptive text of specific

learning disorder. The DSM-5 Neurodevelopmental Work Group concluded that the many definitions of

dyslexia and dyscalculia meant those terms would not be useful as disorder names or in the diagnostic

criteria.

Broader Approach for Targeted Care

Broadening the diagnostic category reflects the latest scientific understanding of the condition. Specific

symptoms, such as difficulty in reading, are just symptoms. And in many cases, one symptom points to

a larger set of problems. These problems can have long-term impact on a person’s ability to function

because so many activities of daily living require a mastery of number facts, written words, and written

expression.

Early identification and intervention are particularly important. The broader DSM-5 category of specific

learning disorder ensures that fewer affected individuals will go unidentified, while the detailed specifiers will help clinicians effectively target services and treatment.

DSM is the manual used by clinicians and researchers to diagnose and classify mental disorders. The American Psychiatric Association (APA) will publish DSM-5 in 2013, culminating a 14-year revision process.